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We often discuss the placebo effect with respect to research studies. Less talked about is it's evil cousin which known as the nocebo effect. In addition to the material discussed in this article, I recall reading reports of drug studies where patients had dropped out of the placebo arm of the trial due to negative side effects.

Can just telling a man he has cancer kill him? In 1992 the Southern Medical Journal reported the case of a man who in 1973 had been diagnosed with cancer and given just months to live. After his death, however, his autopsy showed that the tumour in his liver had not grown. His intern Clifton Meador didn't believe he'd died of cancer: "I do not know the pathologic cause of his death," he wrote. Could it be that, instead of the cancer, it was his expectation of death that killed him?

This death could be an extreme example of the "nocebo effect" - the flip-side to the better-known placebo effect. While an inert sugar pill (placebo) can make you feel better, warnings of fictional side-effects (nocebo) can make you feel those too. This is a common problem in pharmaceutical trials and a 1980s study found that heart patients were far more likely to suffer side-effects from their blood-thinning medication if they had first been warned of the medication's side-effects. This poses an ethical quandary: should doctors warn patients about side-effects if doing so makes them more likely to arise?

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